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Kathleen Weber's avatar

When I was getting on SSRI's I had a bad reaction to Zoloft. It made me feel jazzed and made sleep onset difficult. Fortunately, citalopram works great for me. But that experience was enough to prove to me that these medications have different impacts on different people.

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Sofia Jeppsson's avatar

One could just as well ask psychiatrists who present an overly rosy picture this:

"If one person becomes reluctant to seek care because they hear stories from patients whose concerns were dismissed, who weren't properly informed of the risks before they tried the medication, who were then disbelieved by their doctor when they complained about serious side effects or withdrawal symptoms - HOW WOULD YOU FEEL?"

Because this totally happens.

These "rosy" psych docs live in a world of their own where psych patients never talk to each other. In a world where each psych patient has sane and neurotypical friends and acquaintances only. In a world where psych patients don't even have internet access. Therefore, you can paint a picture as rosy as you like and it will never be a problem, since YOU are your patient's only source of information. Like WTF. Maybe YOU should go to therapy and discuss how you came to develop these strange delusions.

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Thomas Armstrong's avatar

Dr. Aftab, I wonder what you think of the claims of mind-body medicine / Pain Reprocessing Therapy practitioners like Howard Shubiner, who have gone from somewhat fringe toward mainstream through their Boulder back pain study (Ashar et a., 2022, JAMA Psych). In particular, I wonder if you think some of the discontinuation symptoms could be, in their terms, the brain continuing to maintain the symptoms (e.g., the sexual dysfunction side-effects) after the original causes pass or nocebo effects based on imagined "strain on the body" to quote the person micro-tapering from the "Surviving Antidepressants" forum (which may be a nocebo induction in itself). In the case of the persisting sexual dysfunction symptoms, this would be another kind of "physician disbelief," but one that would suggest something "real" going on besides persisting depression, and it would suggest a treatment (PRT or another CBT variant for somatic symptom disorders, perhaps combined with sexual dysfunction therapy elements). I guess your answer is in the op-ed--we need research on discontinuation to address these questions. That said, I would be interested in any thoughts you have on the Sarno/Shubiner/PRT/mind-body medicine movement, because they make strong claims about conditions/symptoms being psychogenic ("mind-body"; "neuroplastic"), and they are aggressively disseminating their perspective and treatment approach (documentary, book timed with publication of study, coaching certifications, etc.).

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